FHIR and Primary Care Systems;
and a FHIR Query Tool
Robert Worden
Open Mapping Software Ltd
robert@OpenMapSW.com
Swindon CCG – Referrals from GPs to
Urgent Care Centres
• GPs to refer selected appointments to Urgent Care
Centres (UCC)
• Send patient’s care record from GP system to UCC
system
• Send updated care record back from UCC system to GP
• GPs use EMIS Web, INPS, TPP
• UCC uses EMIS Web
• Using FHIR as a common exchange format
• Not REST - push from the GP system (GP in charge)
• Black Pear and Open Mapping Software developing
• First proof of concept tested (EMIS only)
Technical Approach
• Using Black Pear’s Pyrusium framework
• Pyrusium provides a web app container, with browser on the GP
Desktop
• Pyrusium injects a javascript library to the web app which allows
interaction with EMIS Web via the api.
• GP composes referral
• Extracts patient medical record in EMIS Open XML
• Transformed to FHIR resources (developed through mappings)
• Sent to UCC system
• Transformed to EMIS Open medical record (round trip) and input to
UCC .
• UCC sends back updated care record by the same route.
Technical Architecture
Storyboard: Making the Referral
Transforming the EMIS Open Patient
Record to FHIR
• Not a document or FHIR composition ; a bundle of FHIR resources:
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Patient
Practitioner
Encounter
Condition
MedicationPrescription
Medication
AllergyIntolerance
Observation
Transforms and round-trips developed from mappings
No FHIR resource profiles needed (yet)
No need to be concerned about deep document structures
Semantic issues arise mainly from the EMIS web side, not the FHIR
side
Semantic Issues
• These have not arisen from limitations of the FHIR resource models
(yet)
• Ambiguities in interpreting elements in EMIS Web XML
• Arise from how EMIS is used by practitioners to record information
• Events may be nested inside consultations, or in event lists
• Similar looking <event> element may represent a medication
prescription, a condition, or an observation
• But events have Read codes
• HSCIC have published mappings from Read codes to Care Record
Events
• We are using these mappings to disambiguate EMIS events for
transformation
Current Developments
• Will extend this work to INPS, TPP
• FHIR interfaces to GP systems are usable in other
contexts – e.g. integration with Social care,
community care, Health Information Exchange,...
• An increasing range of applications are becoming
FHIR enabled (GP systems, PAS, MPI, Social
Care...)
• Eases the path to local integration (FHIR is
simpler, FHIR APIs exist)
• May be relevant to GPSoC 2 Standard Open APIs
GPSoC 2 Standard Open APIs
• GP System suppliers now provide Open APIs under
GPSoC 2.
• But each GP system has a different Open API
• The NHS England intention is to move towards one
standard Open API for GP systems.
• Part of a broader Open API strategy
• Should the GPSoC APIs be based on international
standards?
• Should they align with other open APIs used in NHS?
• Is FHIR a candidate for the GPSoC Open API?
GPSoC Open API: Choices
Use
International
Standards
FHIR
CDA
V3
V2
13606
OpenEHR
GPSoC
Standard Open
API
UK Local
Solution
?
Is FHIR a candidate standard for non-document applications?
Need for a FHIR Query Tool
• Semantic issues often arise from the non-FHIR
end of an exchange
• When FHIR interfaces exist, you can use FHIR to
explore these issues
• Need to compare FHIR resources side by side
from one or more FHIR servers, or FHIR sources
• Need convenient ways to select resources (i.e use
FHIR search) , compare and save them
• OMS are developing a query tool
FHIR By Example
• Interactive, web-based query tool
• Can query any FHIR server, for any FHIR
resource
• Compare resources from different servers side
by side
• Define selection of resources by filling in the
blanks (like Query by Example, QBE)
• One table per resource; columns defined by
configuration files
Startup
• Configured to access selected servers, for selected resources
• Gets server metadata (Conformance resources) to check
which servers support which resource
• Shows this information as a matrix
Showing Resource Tables
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Table columns are defined in a configuration file
Second row allows input of QBE filter criteria
Uses logical ‘AND’ of criteria entered
Uses FHIR search when supported by the server; otherwise
filters resources itself
Running Searches
• Enter criteria in QBE cells, then hit ‘Search’ button
• Sends search requests to all active servers
• Filters and displays results
Using Query Results
• Sort results by any column for comparisons (within or across
servers)
• Manual filtering of resources
• Save results, as a table or resource bundle
Status & Plans
• Currently a wire-frame prototype; but it works
• Considering how to do joins between
resources
• Runs as a web service under Tomcat
• Will be a free download from OMS website
• Beta testers needed soon
• Contact rpworden@me.com for details.